Atrial flutter historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]


The term flutter first appeared a century ago in 1887, with Mac William who described the visual phenomena resulting from ‘faradic stimulation of the auricles which sets them into a rapid flutter.Its first description a century ago, our understanding of atrial flutter (AFL) has evolved, from a relatively simple and unique electrocardiographic (ECG) pattern corresponding to a right atrial macroreentry, to a variety of atrial tachycardias (ATs) originating from the right atrium as well as the left atrium, and resulting from different mechanisms. The use of multielectrodes catheters and the recent development of sophisticated computerized electroanatomical mapping with virtual anatomical chambers reconstruction and fusion with the actual anatomical radiological image has improved our knowledge of AFL circuits and foci location. These technological improvements have also facilitated curative treatment with radiofrequency (RF) catheter ablation while simultaneously creating some terminological and conceptual confusion about its nature.

Historical Perspective

  • The term flutter first appeared a century ago in 1887, with Mac William who described the visual phenomena resulting from faradic stimulation of the auricles which sets them into a rapid flutter.[1][2]
  • It was only 23 years later that Jolly and Ritchie, using the Cambridge model of Einthoven's string galvanometer recorded the first ECG example of AFL.[3]
  • A single wave circus movement mechanism was initially proposed by Lewis, but the possibility to reproduce the ECG morphology of AFL with high pacing rate or with focal aconitine injection supported a focal mechanism as another possible hypothesis.[4]
  • Both mechanisms are easily observed, the circus movement theory has been finally accepted as being by far the most frequent in man.[5]
  • A macroreentrant mechanism was finally proven by detailed mapping in the operating room, as well as in the electrophysiology laboratory.[6]


  1. McWilliam JA (October 1887). "Fibrillar Contraction of the Heart". J. Physiol. (Lond.). 8 (5): 296–310. doi:10.1113/jphysiol.1887.sp000261. PMC 1485090. PMID 16991467.
  2. SCHERF D, TERRANOVA R (October 1949). "Mechanism of auricular flutter and fibrillation". Am. J. Physiol. 159 (1): 137–42. doi:10.1152/ajplegacy.1949.159.1.137. PMID 15391089.
  3. Jolly WA, Ritchie WT (January 2003). "Auricular flutter and fibrillation. 1911". Ann Noninvasive Electrocardiol. 8 (1): 92–6. doi:10.1046/j.1542-474x.2003.08114.x. PMID 12848819.
  4. Levy, Robert L. (1926). "AURICULAR FIBRILLATION WITH REGULAR VENTRICULAR RHYTHM AND RATE OVER SIXTY". Archives of Internal Medicine. 38 (1): 116. doi:10.1001/archinte.1926.00120250121008. ISSN 0003-9926.
  5. "AURICULAR arrhythmias". S. Afr. Med. J. 27 (42): 925–6. October 1953. PMID 13122200.
  6. SCHERF D (February 1947). "Studies on auricular tachycardia caused by aconitine administration". Proc. Soc. Exp. Biol. Med. 64 (2): 233–9. doi:10.3181/00379727-64-15754. PMID 20287386.